Volume 11 • Number 1 • SPRING 2017

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2 the Canadian PODIATRIST • Spring 2017 CFPM CONTACTS

PRESIDENT Dr. Brian Johnson – Saint John, NB 1-888-706-4444 Volume 11 • Number 1 • SPRING 2017 CEO Stephen Hartman – Waterloo, ON 1-888-706-4444 IN THIS ISSUE... BOARD OF DIRECTORS President’s Message: Your Crash Course to Website Stats Trina Scarrow – Milton, ON D.P. By Melody Gandy-Bohr ...... 21 Tina Rainville – Timmins, ON Dr. Brian Johnson, ...... 4 Dr. Helen Rees – Saint John, NB Secrets of Success: Medical Emergencies in Your Office? Dave Kerbl – Ottawa, ON Being a Professional They Do Happen! By Julie C. Fraser ...... 22 Dr. Georgie Evans – Swift Current, SK By Lynn Homisak ...... 5 Ed Moloy – Orillia, ON Drumming for Diabetes Stephanie Playford – Burlington, ON Professional Progress Through By Amanda Birch ...... 25 Leadership: The UK Experience Secrets of Success: Your Hiring Checklist COMMITTEES By Craig Hunt ...... 6 Conference – Stephen Hartman By Lynn Homisak ...... 27 HPRAC – Stephen Hartman Palmo-Plantar Pustulosis and Psoriasis: CFPM 2017 Annual Conference ...... 28 Insurance – Stephen Hartman The Same But Different? Assistant Development – Tina Rainville Ivan Bristow & Mark Cole ...... 9 Foot Health Month ...... 29 Foot Health Month – Dr. Helen Rees Highlights – 2016 CFPM Annual Classified Ads...... 32 Conference...... 13 the Canadian PODIATRIST Upcoming Events ...... 35 Philanthropic Work of Michener Alumni: EDITOR Global Impact Cindy Hartman 1-888-706-4444 By Michener Institute ...... 15 ADVERTISING & CLASSIFIEDS Cindy Hartman 1-888-706-4444 Anatomy of a Google Search: PUBLISHED BY Search Algorithms and How They Affect CFPM Your Practice Submitted by Officite ...... 19 DESIGNED BY St. Jacobs Printery Ltd. PRINTED BY St. Jacobs Printery Ltd. CFPM 200 King St. S., Waterloo, ON N2J 1P9 1-888-706-4444 Fax: 519-888-9385 www.podiatryinfocanada.ca

DISCLOSURE Professional Progress Through The Editor and Board of Directors of the Leadership: The UK Experience Canadian Federation of Podiatric Medicine do not accept responsibility for opinions expressed page 6 by contributors to the Journal; and while every effort is made to ensure accuracy, they cannot accept responsibility for any inaccuracies in the information provided. CFPM 2017 © Canadian Federation of Podiatric Medicine, Annual Conference Spring 2017 page 28 Publication Number 42242022

Foot Health Month page 29

May is Foot Health Month!

Talk to your chiropodist or podiatrist about the treatment and prevention of foot problems.

Visit www.podiatryinfocanada to find one near you or call 1-888-706-4444 the CanadianCanadian PODIATRISTPODIATRIST •• SpringSpring 20152017 3 Message from the President by Dr. Brian Johnson, D.P.

WORKING TOGETHER I would also like to dispel a popular misconception that TO ACHIEVE MUTUAL GOALS graduates of the U.S.A schools opposed and did little to assist in the creation of what is today the Michener program. In 1981 with U.S.A graduates providing the vast majority s I begin my year as President, of podiatric care in Canada I feel it is understandable that I would like to thank all our they wanted the Michener program to be similar to the A members and our hard working U.S.A programs that they had graduated from. Due to the executive for the continued success of differences in the U.S.A and Canadian health care system. Canada’s largest and most influential podiatry association. With the corresponding similarity between the British and The Canadian Federation of Podiatric Medicine. Canadian Health Care systems the government of Ontario Special mention of Stephen Hartman. Who in the last opted for a British style program. year served both as President, and C.E.O. during which time Though the resistance to Ontario’s decision by a small he organized a fundraiser in relation to H.P.R.A.C., which has number of U.S. graduates is well known. Less well known resulted in the C.F.P.M. having approximately $100,000.00 is the fact that Dr. Brian Brodie and I during the curriculum available to utilize if necessary upon the release of the development stage of the program met frequently with H.P.R.A.C. document and recommendations. Dr. Kel Sherkin and Dr. Glen Copeland. Two prominent This year the C.F.P.M provided funds to the New Brunswick Toronto and U.S graduate podiatrists who provided valuable Podiatry Association to aid in its pursuit of prescription rights input into the development of the original chiropody program in that province. curriculum that is still in use today. In the past the P.E.I Podiatry Association has received With U.S graduates now teaching at the Michener. The financial assistance in its pursuit of Podiatry Legislation. Canadian Podiatry profession has in 35 years come full circle. Due mainly to our C.E.O’s efforts and good management, Although differences in scope of practice still exist. They we are now in a position to help our Ontario members in are over time converging. There is only one North American relation to the H.P.R.A.C process. Podiatry profession. One of the objectives of the C.F.P.M is to strengthen our The C.F.P.M. is fully committed to working with the profession through unification. American Podiatric Medicine Association to achieve our With less than 1,000 podiatrist coast to coast. In order to mutual goals. protect the patients and the podiatrist position in the health care system. We need to speak with one voice. This week I received an e-mail requesting information “In order to protect the patients on the New Brunswick Podiatry Association by-laws. As the C.P.M.A. wishes to put the N.B.P.A on its web page. They and the podiatrist position in the are also welcoming D.P. or B.Sc. or D.P.M graduates to join the C.P.M.A. Given that many Michener graduates fall in to health care system. We need to the D.P. and B.Sc. categories. I feel that the C.P.M.A is to be congratulated for this unity building initiative. speak with one voice.”

Honorary CFPM Membership Award The CFPM is pleased to present an Honorary CFPM Membership Award to Dr. Suresh Ram. Dr. Ram has been practicing podiatric medicine for over 50 years. Originally born and raised in Kenya, Dr. Ram currently practices in Regina, SK. During his time in podiatry, Dr. Ram has seen many changes to the profession. One of the biggest change has been the increase in public awareness and the increase in demand for services. Patients have become more aware of available treatments and services. When asked about his secret to longevity, Dr. Ram says he enjoys working with people and attempts to learn something new every day. Dr. Ram has been a proud member of the CFPM for many years and we are pleased to recognize his achievements and commitment to podiatric medicine. Congratulations to Dr. Suresh Ram on his Honorary CFPM Membership Award.

4 the Canadian PODIATRIST • Spring 2017 SECRETS OF SUCCESS: Being a Professional by Lynn Homisak, SOS Healthcare & Management Solutions, LLC

ometimes you can’t identify what something is…until you for a minute”, he swiftly left. He offered no discussion of stop and think about what it isn’t. Such is the case with a treatment plan, did not ask if I had any questions or Sprofessionalism. Several years ago, I visited a new MD’s needed further explanation, no indication of follow up...no office…not as a consultant, but as a new patient. The doctor goodbye! Huh? I thought for sure he’d come back; that he just came highly recommended with a multitude of degrees. In left to get something, but he never did. Instead, a few minutes fact, you couldn’t miss them as you stepped through his front later, Helen returned and pointed me to the discharge desk door; his notable credentials where “you can take care of covered every inch of space on “I realized that just because one works your co-pay.” I’ll spare you their his reception room wall. Very patient discharge protocol. As impressive! After standing there in a profession, it does not automatically you might guess, my experience for a minute or two, taking it all in, didn’t improve. I realized I’d received no make them a professional.” My first thoughts as I left welcome from the staff so I the office were…did this really walked up to the desk, smiled just happen? I envisioned that and announced that I had arrived for my 2:30 appointment. for a comedian the visit would have been humorous fodder Without looking up at me, the receptionist crossed off my for his/her next routine. And while I felt I was pranked, I would name on a sheet lying in front of her, asked for my insurance probably have appreciated the comedic spin. However, at the card and positioned a clipboard to fit exactly in the tiny moment, there was nothing amusing about this. After the way window space that separated me from her, instructing me to I was treated, why on earth would I ever want to come back “have a seat and fill this out.” I did as I was told, returned here again? the completed form [still no eye contact] and sat back down. That got me thinking…what do I expect from a When my name was called, I was escorted into the treatment professional? And what did I learn from this experience? room by the nurse [I think?]. She also didn’t introduce herself I realized that just because one works in a profession, it does and wore no identification badge, so I asked her name in the not automatically make them a “professional”. hopes of starting a conversation. “Helen,” she responded and I bet if you asked a room full of people what profession- without pause pointed to a nearby chair in the room and said, alism means to them, it’s likely you would hear any number “Have a seat.” She went about her robotic routine…asked of expected qualities such as altruism, ethics, compassion, some basic clinical questions, took my blood pressure and knowledge, competence, respect for others, integrity, trust pulse, made some notes and when she had all she needed, responsibility/accountability, image and appearance and turned to walk out of the room. As she was leaving, she never teamwork. Individually, none of them would be wrong; how- looked back; just said, “The doctor will be in.” Zero personality; ever, it is all of them together that captures the true definition. zero interaction. The lecture topic ‘How to be More Professional’ is rarely I sat alone…waiting…and waiting…when finally, in walked [never] on a podiatry conference schedule, and it should be! the doctor. At least I thought it was the doctor; no white coat Because if you do not think professionalism plays a critical to distinguish him and once again, no formal introduction. role in how your patients perceive you and whether or not they I could tell right away that he was not a “small-talk-kinda- stay with you, think again. The doctor I visited may have been guy”, so I smiled and said hello, hoping to break the awkward a GREAT clinician; he certainly had the credentials indicating silence. He looked down at my chart in his hands, glancing he was. So what. Based on my first impressions and how I up over his glasses for a quick second to make eye contact, was treated, I will never return. And if statistics are correct, nod and say hi (and I supposed to determine if someone was I will likely tell 10-12 other people about my bad experience. actually sitting in the chair). He then sat down and immediately Maybe, I’ll even write an article and tell the whole world! started dictating information into his hand-held recorder that I Bottom line, it doesn’t matter how many certificates or only assumed he pulled from Helen’s notes. He mumbled so degrees you have on your walls, how much money you have softly that I couldn’t make out what he was saying…all I knew in your pockets, what your status in the profession is, what was that he wasn’t speaking to me. Our interaction consisted kind of car you drive or what university you went to. It’s about of a series of questions from him, responses from me and how you treat people every day and how they perceive your more recorder-mumbling. What lasted all of 6 minutes was behavior that sets the stage for your success. In the words of hardly what you’d call a conversation. He warned me about John Wooden, UCLA coaching legend, “Ability may get you to the dangers of cholesterol, handed me a pamphlet and a the top, but it takes character to keep you there.” slip for a blood test. After instructing me to “stay in the room

the Canadian PODIATRIST • Spring 2017 5 PROFESSIONAL PROGRESS THROUGH LEADERSHIP: The UK Experience PRESENT Offers the Perfect Balance of Online By Craig Hunt, B.Sc., D.Ch. PgD. MChS and Live CME for Canadian Podiatrists

just returned from the UK’s College of Podiatry’s 2016 areas of research and publication. Our profession is poorly conference in Glasgow this past weekend – November 17- served by an institution that merely serves up compressed I 19th. This con-ed event was preceded by me attending two didactic education alone without fostering research. We excellent conferences the CFPM national conference and all realize that the government fabricated and dictated the APMA national sports medicine conference. All excellent the educational model and placed the glass ceiling on the Online CME Live Conferences conference’s for learning and interacting with our colleagues opportunities of chiropodists trained in Ontario. They fashioned PRESENT provides over 300 effective PRESENT offers five premier annual from all over the world. the model at the time on the British model. The salient fact online CME Lectures, delivering live podiatric conferences totalling The exciting and exhilarating observation of the UK illuminated at the UK conference is that the UK podiatric thousands of hours of Online CME more than 80 Live CME Credits national conference was the educational model has accelerated credits per year integration and teamwork that and modernized in keeping with exists between the regulatory progressive educational systems body, schools, and professional “Ontario has a real opportunity to whereas Ontario has stultified. association. This teamwork modernize and first catch up The UK Podiatry Profession amongst these three groups has been very much leaders in and has forged a strong and then lead in podiatric medicine.” helping facilitate growth through progressive bond built on short guidance to the largest national and long-term vision and goals podiatric association in Canada- the for podiatric medicine and CFPM. It was good to see CFPM CEO surgery in the UK. The depth and knowledge of speakers was Stephen Hartman give a plenary lecture before the largest astounding. For me the academic poster section amplified podiatric conference. It was equally rewarding to see many of the leadership in research that is taking place in UK Podiatry the British podiatry leaders such as Drs. Borthwick, Bristow, schools and reflected in the high impact factor of The Journal Potter, and Professor Stuart Baird who have steadfastly offered of Foot and Ankle Research. Both of these progressive educational and academic leadership to their colleagues. changes highlight the chasm between the educational system Ontario has a real opportunity to modernize and first catch in Ontario and polarization between the regulatory body, up then lead in podiatric medicine. It can forge and enhance the and school. The professional associations have been the current education that will better serve Ontarians. It behooves real leaders in con ed in Ontario with a rather insipid role the policy makers to push forward from last centuries model being played by the school. That truly is a pity, and there and make the bold progressive changes required for the 21st needs to be a better coordinated and leadership role by the century and beyond – the UK has. It would be a real pity if school. It maybe they lack the initiative—but the days of saying Ontario out of fear or malady failed to make the changes. can’t, or will not needs to be replaced with CAN and will in

CFPM Attends the UK Society of Chiropodists and PRESENT recently conducted the largest poll ever of podiatrists’ Podiatrist Annual Conference in Glasgow, Scotland attitudes and opinions regarding their CME Requirement* Stephen Hartman, CFPM CEO recently attended the UK Society of Chiropodists Podiatrists report they LEARN MORE from PRESENT 75% of Podiatrists receive MORE THAN HALF of their and Podiatrists Annual Conference in Glasgow, Scotland, as an invited speaker. Online CME than from ANY OTHER FORM of CME CME via Live Conferences His lecture “The Seven Stages of the Podiatric Practice Business Life Cycle” was an opportunity to reach the U.K. podiatrists in private practice. >90% of Podiatrists HIGHLY VALUE the option to earn Live Conferences offer network opportunities and the The UK Society of Chiropodists and Podiatrists Annual Conference is one of all their CME online and in print media chance to physically engage with new technologies the largest annual podiatry conferences in the world with over 1200 delegates, Podiatrists consider PRESENT Online CME the LEAST Live Conferences are still the way Podiatrists earn 80 exhibitors and 100 speakers. The UK Conference was also an opportunity for EXPENSIVE form of CME per credit hour earned MOST of their CME credit the CFPM to continue fostering its relationship with the UK College of Podiatrists. Also in attendance were several Canadian practitioners. The 2017 UK Conference will be held in Liverpool. Podiatry.com PRESENTConferences.com *For detailed results and survey analysis, visit Podiatry.com/cmesurvey

6 the Canadian PODIATRIST • Spring 2017 PRESENT Offers the Perfect Balance of Online and Live CME for Canadian Podiatrists

Online CME Live Conferences PRESENT provides over 300 effective PRESENT offers five premier annual online CME Lectures, delivering live podiatric conferences totalling thousands of hours of Online CME more than 80 Live CME Credits credits per year

PRESENT recently conducted the largest poll ever of podiatrists’ attitudes and opinions regarding their CME Requirement* Podiatrists report they LEARN MORE from PRESENT 75% of Podiatrists receive MORE THAN HALF of their Online CME than from ANY OTHER FORM of CME CME via Live Conferences >90% of Podiatrists HIGHLY VALUE the option to earn Live Conferences offer network opportunities and the all their CME online and in print media chance to physically engage with new technologies Podiatrists consider PRESENT Online CME the LEAST Live Conferences are still the way Podiatrists earn EXPENSIVE form of CME per credit hour earned MOST of their CME credit Podiatry.com PRESENTConferences.com

*For detailed results and survey analysis, visit Podiatry.com/cmesurvey

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8 the Canadian PODIATRIST • Spring 2017 PALMO-PLANTAR PUSTULOSIS AND PSORIASIS: The Same But Different? Ivan Bristow, PhD, Senior Lecturer, University of Southampton Mark Cole, MSc, Programme Lead, University of Southampton

Abstract 30-50 age group and from Palmo-Plantar Pustulosis (PPP) is a relatively uncommon there may show a relapsing affliction of the glaborous skin of the hands and feet and remitting pattern for frequently associated with psoriasis. In recent years there many decades afterwards. has been much debate around whether the two conditions Studies have shown that are the same or distinct clinical entities. PPP is characterised around 20% of PPP patients by scaly plaques with an erythemic base studded with sterile with have a family history pustules and shows subtle but significant differences in its of psoriasis and evidence clinical presentation when compared to psoriasis. In addition, of psoriatic lesions the disorder is frequently a chronic condition and is refractory elsewhere on the body [5]. to treatment. This paper reviews the current knowledge of the Interestingly, reports of PPP condition, its known associations and management. progressing into psoriasis have not appeared. Of Introduction most interest, is the link PPP is a relatively uncommon condition which is between smoking and the characterised by symmetrical, erythemic patches of scaly development of PPP. The epidermis which is studded with minute 2-4mm pustules first reports emerged in the (figure 1). It is most commonly located on hands and feet 1980’s from Japan and the (particularly the thenar and hypothenar eminence on the palms UK [6]. One study from Japan and the central and lateral portions of the plantar surface). highlighted the elevated The condition begins with a developing area of erythema incidence in smokers [7] Figure 1 which then goes onto erupt with minute sterile pustules, whilst other work confirmed coalescing to form larger collections within the epidermis. As these findings. Rosen found the condition progresses pustular lesions may darken and dry 94% of patients in his cohort to be smokers at the time of out. Flaking of the lesions reveals a thin underlying epidermis onset of their disease [8] whilst similar figures of 92% were with fissures and hyperkeratosis frequently accompanying the discovered in a Brazilian [9] and an African study [10]. A British condition. case-control study demonstrated over 80% of PPP patients PPP generally exhibits a chronic pattern with relapsing were current smokers compared to just 36% of controls, whilst and remitting episodes. The patient may experience pain and only 10% of persons with the disease had never smoked. Of discomfort whilst weight bearing. Quality of life (QOL) studies those 16 patients who had stopped smoking after diagnosis, for patients suffering with this disease are sparse and general there had been no improvement in their condition [4]. Other dermatological QOL measures may not be suitably sensitive work has suggested only slight improvement of the condition for PPP [1]. Despite a small body area percentage being after smoking cessation but small numbers in this study were affected, lesions on a dominant hand or on the foot may have a limitation [11] suggesting the habit to be a trigger for the significant impact on ambulation and daily activities. In a study condition. of 317 patients with palmoplantar psoriasis and psoriasis, patients with plantar and palmar involvement demonstrated Aetiology more physical discomfort and disability than those without The link between smoking and the onset of PPP is not [2]. This was confirmed in a later study which demonstrated entirely clear but may suggest its aetiology. Eriksson and that patients with PPP were more likely to report lower QOL colleagues [12] undertook a unique histological analysis scores in mobility and usual activities compared to those with to uncover possible reasons. Using a comparison of control widespread moderate to severe psoriasis, suggesting it to be smokers and those with PPP, histological analysis has more of a problem [3]. demonstrated destruction of the sweat duct within the epidermis with a localised pustule formation to be a key feature Epidemiology of the disease. Neutrophil numbers are known to be increased PPP is a disorder which predominantly affects women with the disease [13]. Examination of pustule contents has much more frequently than men with estimates suggesting a ratio of 5:1 [4]. The condition typically onsets adults in the Continued page 11

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0 1 the Canadian PODIATRIST • Spring 2017 Continued from page 9 common co-morbidity. One study highlighted abnormalities in TSH, Thyroxine and Thyroperixoidase levels in patients with shown them to be rich in neutrophils and eosinophils along PPP (even at a sub-clinical level) [12]. In another study of 12 with accumulations of high numbers of mast cells below the patients, 25% were demonstrated to have co-existing thyroid pustule within the dermis along with lymphocytes. Interestingly, pathology [24]. Other studies have confirmed these findings IL-8 is a chemoattractant for both eosinophils and neutrophils [8, 25, 26]. The reasons for this association are unclear but which has been shown to be present within the sweat duct and it has been suggested that similarities in the homology of within the epidermis of patients with PPP. Moreover, mast cells these hormones and cell function of the thyroid bears close are known to be able to secrete IL-8 suggesting their role in the resemblance to the keratinocyte [12] leading to cross over in pathogenesis of the disorder [12]. More recent research has its effects. Other AI disease which has been reported to co- confirmed the sweat duct to be the main area of inflammation exist includes gluten intolerance (coeliac disease) [12, 27] with the disease [14]. and disturbances in calcium homeostasis [28]. Sweat glands in the palms and soles are part of the Beyond AI disease other potential co-morbidities have sympathetic nervous system – sweating being activated been proposed. In a Scottish study of 73 patients diagnosed by Acetylcholine (ACh). Levels of the neuro-transmitter are with PPP, a survey was undertaken looking at coincidental balanced by local enzymes – choline acetyltransferase diseases. In their data they discovered 27% had active plaque (ChAT) acetylcholinesterase (AChE) regulate the ACh level by psoriasis, 2% had a family history of PPP whilst there were synthesizing and degrading ACh respectively. However, more 24% with Ischaemic heart disease, 38% with hypertension and recently it has been shown that keratinocytes are able to 49% dyslipidaemia which was higher than expected leading produce these enzymes themselves. There are two known the authors to suggest that lipid profiles be measured in PPP types of ACh receptor – nicotinic and muscarinic. Receptor patients as it is a strong risk factor for IHD. Interestingly, 29% sites in different parts of the body are uniquely constructed of of this group were diagnosed with depression suggesting the particular sub-units which governs their individual functions. effect of the chronic skin disease has on patients [27]. The When nicotinic receptors are exposed to nicotine, it has an higher rate of depression in PPP patients had also reported ACh agonist effect but does not get degraded by AChE thus in an earlier study along with a slight increase in the risk of potentially having a prolonged stimulatory effect. Hagforsen diabetes [28]. [15, 16] focused attention on the sweat duct itself and A number of researchers have examined allergies amongst discovered that the distribution of nicotinic receptors was PPP sufferers as a possible aggravating pathology [29-31]. In altered in smokers hypothesizing that nicotine exposure was a paper reviewing 21 patients with diagnosed PPP, patch tests responsible for triggering inflammation of the sweat duct in were positive in 60% of patients. Typical allergens identified PPP patients. His experiments indicated that inflammation included nickel, formaldehyde, mercury, neomycin and balsam and pustule formation was brought about by immune cross- of Peru with the authors suggesting co-existing allergy may reactivity against specific sub-units within the sweat duct prolong the symptoms of PPP [32]. Other case reports have receptors, which was up regulated in smokers, leading to the highlighted spontaneous regression of PPP following removal conclusion that the disorder is an auto-immune process. of metal implants suggesting a high probability of allergy Other causes of the condition have been discussed. behind the pustulosis [33-35]. Since the 1960’s a condition has been recognised which characteristically shows osteo-articular manifestations PPP & its association with psoriasis accompanied by a pustulosis. Termed SAPHO syndrome Psoriasis is a common disorder characterised by (synovitis, acne, pustulosis, hyperostosis and osteitis), it is a erythematous plaques arising on the skin with detachable rare condition occurring in children and adults [17]. Clinically, silvery scales. Within its clinical spectrum exists a number since the introduction of biological agents, a number of cases of variants such as guttate, inverse or flexural psoriasis and of PPP have been documented as being triggered by patients less commonly acrodermatitis continua of Hallopeau, for taking medicines [18] such as adalimumab, entanercept, example. PPP in many texts is also traditionally referred to as rituximumab and infliximab [19-22] which most likely a localised form or “variant” of psoriasis but recently this has represents an adverse reaction to the drug which based on been challenged, and remains unresolved, although evidence current case reports appears to be a rare finding. of it being a separate entity is increasing. Following on from earlier work [36], a study examining PPP & other comorbidities the presence of the PSORS1 gene in patients with psoriasis The hypothesis that PPP is an autoimmune (AI) disease vulgaris, guttate psoriasis and PPP was undertaken in 2003. can be strengthened when looking at patients with the disease. The results demonstrated that although the psoriasis vulgaris One feature of AI disease is that sufferers generally are at risk and guttate psoriasis showed strong associations with the of having more than one AI condition [23]. Previous surveys gene, no such link was demonstrated with PPP [37] casting of patients with PPP have uncovered a range of co-existing conditions. Firstly, thyroid disease has been shown to be a Continued page 30

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2 1 the Canadian PODIATRIST • Spring 2017 HIGHLIGHTS: 2016 CFPM Annual Conference

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the Canadian PODIATRIST • Spring 2017 13 4 1 the Canadian PODIATRIST • Spring 2017 PHILANTHROPIC WORK OF MICHENER ALUMNI: Global Impact Submitted by The Michener Institute

hat diseases or conditions do you think have some Canadian doctors, nurses and other health care professionals of the highest mortality rates? Different kinds who called themselves The Guyana Diabetes and Foot Care W of cancers or infectious diseases might come to Project. She, along with other members of the team, has mind, but according to Michener alumnus Laura Lee Kozody, returned to Guyana several times since then. the answer may surprise you. Diabetic foot ulcers, a major complication related to diabetes, have higher five-year rates The Guyana Diabetes and Foot Care Project of mortality than breast, colon or prostate cancer, and are one Guyana, located in northern South America, is a of the leading causes of mortality for people with diabetes. multicultural country with people of South Asian, African, and In fact, the mortality rate for diabetic foot ulcers has been Amerindian origins – groups that, according to the American reported to be between 43 per cent and 55 per cent, and up Diabetes Association, are all at high risk of developing to 74 per cent for patients with lower-limb amputations. diabetes. Despite access to universal health care, Guyana experiences a consistent shortage in health care professionals, with an even larger shortage of professionals in specialized areas like chiropody. When The Guyana Diabetes and Foot Care Project team arrived in 2008, diabetes was the fourth leading cause of death in Guyana. The Guyana Project team collaborated with important decision makers in Guyana, from the doctors at Georgetown Public Hospital Corporation, to the Ministers of Health. The urgency of the issue was immediately recognized, but according to Laura Lee, it was important to take the time to come up with sustainable solutions. “You can’t just go [to Guyana] and say ‘this is how to do it’ and then expect the Guyanese professionals to carry it on when they don’t have the appropriate resources,” Laura Lee explained. “The solution must be sustainable.” Laura Lee Kozody (back row, centre) with members of The Guyana Project team.

In many parts of the world, diabetes is a highly manageable disease when coupled with proper care and treatment. However, in countries where resources are limited, diabetes often goes untreated, which can lead to complications such as a diabetic foot ulcer. Without foundational knowledge of diabetes, the primary form of treatment for diabetic foot ulcer is to amputate the affected part of the lower limb. These countries would greatly benefit from the specialized care of chiropodists. Laura Lee is a 1992 graduate from Michener’s Chiropody program. In addition to working as a chiropodist at a private interprofessional practice in Mississauga, for nearly ten years she has devoted herself to philanthropic work abroad with the Laura Lee Kozody (Left) examines the feet of a patient at goal of raising awareness of preventative diabetic care and the newly founded Diabetic Foot Center in the Georgetown recognized best practices. Public Hospital in Guyana. Much of her international volunteer work started after Laura Lee made her first trip to Guyana in 2008 with a group of Continued page 16

the Canadian PODIATRIST • Spring 2017 15 Continued from page 15

After careful consultation and collaboration, the Guyana Project team and Guyanese health care professionals came to tackle the issue in two phases: Phase One, which would take place from 2008 to 2010, and Phase Two, which would take place from 2010 to 2013. The goal for Phase One was to develop a Diabetic Foot Centre within the Georgetown Public Hospital, the country’s largest hospital. The goal for Phase Two was to build capacity across the country by training the health care professionals in each jurisdiction and to create regional diabetic foot ulcer clinics. Training was facilitated in part by Michener’s own Diabetes Educator program. Laura Lee Kozody (centre) instructing health care professionals in Ethiopia on diabetic foot care. The Simplified 60 Second Foot Screening Before the team could focus on the new Diabetic Foot Center, Phase One of the project was largely focused on Beyond Guyana educating local health care professionals on the basics of Thanks to such positive outcomes in Guyana, Laura diabetic care and treatment. Lee and her colleagues realized the potential to extend the “There was a need for the local health professionals to program more broadly. understand how to manage foot ulcers,” Laura Lee explains. “Because the Guyana Project was so successful, the “And if we could succeed in that aspect, then we could shift team found that it was significantly easier to receive funding the focus to preventative care.” [to travel to] other countries with a diabetes epidemic,” she Laura Lee and a few of her colleagues developed a explains. simplified 60-second screening tool to assess the feet of Most recently, Laura Lee traveled to Ethiopia to continue patients with diabetes to identify persons with a high-risk of her work spreading awareness of diabetic foot care. While developing a foot ulcer. The way it worked was simple: working there, she encountered other health care volunteers affiliated off of a checklist, if the assessed foot received at least one with Toronto Addis Ababa Academic Collaboration (TAAAC) positive score, the patient would be referred to the hospital’s from the University of Toronto. new Diabetic Foot Centre for education and treatment. Read about TAAAC in the blog post by Dr. Brian Hodges, This tactic was so successful, that according to statistics EVP Education at The Michener Institute compiled by members of the Guyana Project, in the first four Though volunteering abroad is greatly rewarding, Laura and a half years of the Diabetic Foot Center operations, there Lee says going abroad so frequently is not always an easy was a 68 per cent reduction in the average rate of major decision to make. amputations. “It’s difficult because I am not earning an income in that time [abroad]” she says. “And it’s sometimes hard to leave my practice for longer stretches of time.” But would Laura Lee volunteer abroad again? “Yes, definitely. I don’t have the ability to say no,” she “The solution must be sustainable.” joked.

Dr. Brian Brodie Award for Research: 2016 Winners The CFPM is pleased to announce the 2016 recipients of the Dr. Brian Brodie Memorial Award for Research. Son Hee Jin, Nasim Rezania, Shannon Youn and Weifang Zhang’s research proposal entitled Intralesional Injection of Zinc Sulphate in the Treatment of Verruca, was selected by the faculty of the chiropody program at the Michener Institute as worthy of this prestigious award.

16 the Canadian PODIATRIST • Spring 2017 Introducing the DARCO Body Armor® Pro Term Walker

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ProTerm_OP_FP_1016.indd 1 10/25/16 2:52 PM the Canadian PODIATRIST • Spring 2017 17 8 1 the Canadian PODIATRIST • Spring 2017 ANATOMY OF A GOOGLE SEARCH: Search Algorithms and How They Affect Your Practice Submitted by Officite

aving a strong web presence is crucial to growing your How Search Algorithms Affect Your Practice practice, and being visible to search engines is key to Search engines change their algorithms hundreds of Hthat goal. Research by Google & Compete reveals that times a year to fight blackhat, ‘cheating’ search tactics, and 77 percent of patients use search engines prior to scheduling to improve users’ search-engine experience. Most of these a healthcare appointment, and three times as many visitors algorithm changes are minor; however, search engines to healthcare providers’ websites come from search than occasionally roll out major updates that affect SERP rankings from non-search sources. Search engines can therefore help in significant ways. you market your practice, and if you aren’t using techniques One example is Google’s Hummingbird update. Designed to improve your search engine visibility, you’re missing out on to place greater importance on whole search queries rather potential revenue. than individual keywords, Hummingbird affected 90 percent of all searches and was the most comprehensive update to Search Engines and Search Algorithms Google’s search algorithm since 2001. Explained Keeping abreast of search algorithm changes is key The first step in improving your search engine visibility is to ensuring that your website continues to rank well. One to understand how search engines work. Search engines allow of the best ways to stay ahead of search algorithm changes you to use keywords to search the internet. When you enter and improve your SERP ranking is to optimize your website for keywords into a search engine, programs called ‘web crawlers’ search engines, and then measure and track your success. scour through trillions of web pages, and create an index, or Below are some search engine optimization best practices to list, of relevant web pages. help improve your website’s rankings: Search engines then rank the web pages using programs • Update your website often with quality keyword-rich called search algorithms. Most search engines use several content algorithms, and each algorithm takes hundreds of factors. • Bu ild good quality inbound and outbound links into account when determining how to rank web pages. These • Inclu de a sitemap factors may include domain age, server location, the date and • Make sure your website is fast to load and optimized for quality of content updates, and page load speeds. Google’s mobile devices best-known search algorithm, PageRank, counts the quality Optimizing your website for search engines and staying and number of links to a web page to determine how relevant ahead of search algorithm updates takes time and money. By a web page is to a search, and where it should appear on a outsourcing your digital marketing to a company that serves search engine results page. healthcare practices, you can ensure your practice gets the Search engines present these ranked websites on a search exposure and the expertise that it deserves. Want to learn engine results page (SERP). You have seen this page before – more? Contact Online Podiatry Sites at 855-777-0548. that familiar list of search results that you are presented with after you search for a keyword on a search engine. Each result on the page normally includes a title, a link to the web page, and a description showing where the keywords in the search query match the content on the web page.

the Canadian PODIATRIST • Spring 2017 19 FOR CHIROPODISTS AND PODIATRISTS: CFPM Pedorthic Training Our “sole” commitment The health andand happiness ofof youryour patientpatient Date: Sept. 15, 16 & 17, 2017 More information will be available on the CFPM website after May 1, 2017. Place: Timmins, ON Faculty: Fee: CFPM Members - $700 plus HST Dr. Jack Hutter, D. P.M., C. Ped. Non-Members - $900 plus HST Wisconsin, USA

This course will teach pedorthic theory and application of footwear modifications so that practitioners can implement these skills into their day-to-day practices. Full line of handmade Functional Patrick Rainville, D. Ch. The program will also have a significant hands-on, Timmins, ON Canada Highestand Accommodative Quality Orthotic devices Devices practical component so that attendees leave with both theoretical and practical competencies. Enrollment is limited to 10 delegates.

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Your Crash Course to Website Stats Exceptional cost saving programs HOME | ABOUT US | PRODUCTS | RESOURCES | BLOG | NEWSROOM | EMPLOYMENT | CONTACT | RXFORM by Melody Gandy-Bohr Five day turnaround Free shipping NEW loads the page. While unique pageviews give you insight into Free child outgrowth program Fibrelite the number of site visitors you receive, the overall pageview Lighter Than Air! statistic shows in broad strokes which pages on your site are Pathology Specific Devices most popular with users. iQube and Sharpshape 3D scanning technology available Why Your Bounce Rate Isn’t a Big Deal Your practice website’s bounce rate is the percentage of and much more... visitors who land on your website and leave without looking uilding a sleek and engaging website for your practice at any other pages. While a high bounce rate can mean that won’t mean anything if you don’t pay attention to its users are not finding what they need, it could also mean that performance. The only way to determine if your online B users are finding what they need, and leaving satisfied. If a marketing strategy is paying off is to look at your performance user lands on your homepage looking for your phone number, data. From there, you can build up what’s working well and finds it, and then immediately leaves without browsing to change what’s not working at all. Here’s everything you need other pages, this is a good thing. Depending on your website to know to accurately interpret your practice website’s stats, goals, your bounce rate shouldn’t be a big concern. MAKING GREAT STRIDES • MAKING GREAT STRIDES • MAKING GREAT STRIDES and to understand what site visitors want from your practice. Regularly viewing your practice website’s stats provides useful information that can help you engage users, improve To receive our catalogue or for more information on footwear please call toll free Pageviews vs Unique Pageviews conversions and focus on popular pages. Once you understand 1-800-887-7138 A higher volume of site visitors increases your chances of your website stats, you can provide a better online experience or fax us at (403) 236-8539 gaining new patients. However, don’t confuse a high number that converts users into patients. Contact Officite today to of pageviews with unique site visitors. discuss ways to improve your practice website’s performance. To view our catalogues online visit our website Pageviews are counted every time a user loads a page on 6777 Fairmount Drive SE. your website. A unique pageview is only counted when a new Calgary, Alberta T2H 0X6 user loads a page, regardless of how many times the user

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the Canadian PODIATRIST • Spring 2017 21 Medical Emergencies in Your Office? They Do Happen! by Julie C. Fraser, Doctor of Podiatric Medicine (Reg. Chiropodist ON)

Born and raised in Windsor, Ontario, 1. A written office medical emergency response plan Julie Fraser obtained her Bachelor’s 2. Readily available basic emergency equipment Degree in Science from the Univer- and supplies sity of Windsor. Julie successfully obtained her Doctorate in Podiatric 3. Readily available basic emergency medications Medicine in 2002 in Chicago, IL. She Once you determine the risk profile of your office (Low, then spent five years doing her post- Moderate, High), you can then arm yourself with the essentials graduate training in Philadelphia, at for your Office Emergency Kit. COCOO has published a University of Pennsylvania and her Guideline for Dealing with Office Medical Emergencies in 3 year surgical residency in Reconstructive Foot and Ankle the Podiatry and Chiropody Office Setting that details the Surgery. Julie worked at the Advance Center for Skin & Wound recommendations, risk profile, and essentials for the office and was a Diabetic Limb Salvage Specialist in Frederick emergency kit to prepare you and your staff for handling such Maryland, where she was also in private practice. a situation. Julie is now in her 5th year as owner of Solace Windsor, Our office has a specifically marked kit and Action Plan where she offers comprehensive podiatric footcare and Binder (used in annual reviews/drills) located in a clearly orthotic services. marked place in the office that is quick and easy to access. Annual CPR training and review of the emergency kit/supplies re you prepared for a medical emergency in your is a part of our office procedures. Our office built our own kit office? As healthcare professionals, we treat patients and it was tailored to our specific risk profile. There are now Awith complex medical histories on a daily basis. commercially available pre-set Early recognition of signs and emergency kits with monitoring symptoms that may be indicative and replenishment programs that of an emergency situation and the “…correct equipment, medications, are extremely convenient and basic fundamentals to respond ensure your medications stay with a set procedure is key to a proper training and procedures current. successful outcome. Podiatrists in place greatly reduces the risk…” Having the correct equipment, and Chiropodists, along with their medications, proper training staff, need to be equipped with and procedures in place greatly the skills and knowledge to handle reduces the risk of an unfavourable a medical emergency as it may occur in their office setting. outcome in an emergency situation. Implementing a plan can It has been reported that the average primary care office improve outcomes in an emergency situation and ensure you experiences at least one emergency situation that occurs each and your staff are well prepared. Not only is an emergency year. Respiratory, cardiac, CNS, and endocrine events are action plan essential for most regulatory colleges, but your among the most common issues in office related emergencies. patient’s life may someday depend on it! In my practice we have had the need to call emergency services 2-4 times a year since opening. Our patient volume is REFERENCES high but our high-risk patient volume happens to be low. The 1. Se th L. Toback, “Medical Emergency Preparedness in Office Practice,” medical emergencies that have occurred in my practice have American Family Physician (2007) Vol.75, no.11 p.1679-1684. 2. Frequency of in-office emergencies in primary care. Canadian Family all involved the high risk patient with complicated medical Physician, Vol 55: October 2009 Clare Liddy histories and were over the age of 65 years. The College of 3. Dealing with Office emergencies; Stepwise approach for family Chiropodists of Ontario (COCOO) outlines a Risk Assessment physicians. Canadian Family Physicians Vol 48: September 2002 Ian Sempowski. Profile that can be used to help you determine where your 4. Basic Management of medical emergencies: recognizing a patient’s individual practice level of risk and likelihood of experiencing distress. Journal of American Dental Association. 2010; 141(suppl 1): a medical emergency. The document also references three 20-24. 5. College of Chiropodists of Ontario: Guideline for Dealing with Office recommendations as a framework for an effective office Medical Emergencies in the Podiatry and Chiropody Office Setting, emergency plan: www.cocoo.on.ca/pdfs/guideline-medical_emergencies.pdf

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Reference: 1 - Guideline for Dealing with Office Medical Emergencies in the Podiatry and Chiropody Office Setting. College of Chiropodists of Ontario Approved by Council – June 8, 2012

the Canadian PODIATRIST • Spring 2017 23 Do you have a taste for Knowledge?

Attend the largest wound conference in Canada.

A multidisciplinary event: Sessions for chiropodists/podiatrists, nurses, occupational therapists . . . and more. Topics include: Diabetic foot, infection and limb salvage strategies.

Mississauga, ON · November 16–19, 2017

Register: www.WoundsCanada.ca/events

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4 2 the Canadian PODIATRIST • Spring 2017 Drumming for Diabetes by Amanda Birch

n November 25, I had the pleasure of going to the seventh annual Drumming for Diabetes event at Othe Harbourfront Centre in downtown Toronto. Organized by Anishnawbe Health Toronto, Drumming for Diabetes is a diabetes awareness event for First Nations, Metis and Inuit communities. Before the evening started, the event coordinator smudged the room with burning sage and had everyone meet each other. The evening proceeded with many drumming songs, jingle dress dancers, traditional teachings, dancing, drawing, traditional food, educational booths and many prizes. The night was filled with laughter, dancing and embracing Aboriginal culture to the fullest. Having only was great to see multiple health disciplines come together some exposure to this culture, it was amazing to see the as a team to promote health and wellness for diabetes. Even strength of their beliefs in their traditions and teachings. One though each profession may play a different role in treating of my favourite parts of the night was learning about their a patient, when we are able to work effectively as a team, dances and footwork, and how it we can help prevent diabetes and all has a story to tell. The women improve one’s health in many and men were more than excited ways. to teach us the moves. It was “It was interesting to learn that The Indigenous peoples interesting to learn that having believe strongly in four specific constant connection with Mother having constant connection with aspects of health, including Earth through the feet is very Mother Earth through the feet is very mental, physical, emotional and important during the dancing. spiritual health. As chiropodists Throughout the event important during the dancing.” we can focus on enhancing different educational booths were these areas through proper foot set up to inform everyone about health education and taking early how to stay healthy in many preventative measures for diabetes. different ways. Information to promote diabetes wellness with Our chiropody booth had pamphlets on the Anishnawbe the help of chiropody, physiotherapy, chiropractic, mental clinic and information on how to set up appointments. Inside health and addiction services, dietitians, diabetes education were also helpful tips on how to keep your feet healthy, and youth groups were a few of the many booths set up. It especially with diabetes. Drumming for Diabetes was established to promote healthy living for individuals living with diabetes, as well as preventative measures for those without diabetes. The goal of the event was to get youth involved, promote awareness about diabetes while also taking into consideration traditions and beliefs. Moving forward when working with these communities, it is important to take into consideration beliefs about medicine and traditions, and to try to come up with a treatment plan that satisfies both.

the Canadian PODIATRIST • Spring 2017 25 CUTTING EDGE TECHNOLOGY

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CFPM 0117 - mad science.indd 1 1/16/17 9:29 AM 26 the Canadian PODIATRIST • Spring 2017 SECRETS OF SUCCESS: Your Hiring Checklist by Lynn Homisak, SOS Healthcare & Management Solutions, LLC

aving pleasant and competent staff members is one Conducting the Interview of the most valuable assets a practice can have, so ✔ A void asking any discriminatory questions. (Need a copy Hthe method of choosing them should not be done of what they are? Email [email protected] and I’ll send with minimal effort on your part. Remember, when you hire you one.) someone, your intent should be to hire for keeps because ✔ Inst ead of just asking “How would you handle…”, actually for one, frequent staff turnover is not very reassuring to your role play a scenario for example of an irritated patient who patients. “Why is there a new staff person every time I come to waited too long in your reception room. BE that irritated this office? Is this doctor hard to work for?” Two, it can literally patient and as they step into the role of the new assistant, turn the proficiency of the office upside down. Did you know observe their behavior, reactions, facial expressions, body that it takes approximately 12-18 months to get a new hire up language, consoling words, pauses and hesitations. As a to the same level as a productive staff member who leaves patient, how would YOU feel? your employ? Three, it is costly! Each time you go through the ✔ Giv e quizzes. You can administer a simple on-the-spot hiring process; you undoubtedly face both an emotional and test to determine basic math, spelling, customer service financial beating (via stress on doctors and existing staff due abilities as well as various types of personality, aptitude to lost time and work, recruiting, advertising, interviewing, and volition tests online. Check out www.kolbe.com for one training, correcting mistakes, etc.) that tests conative strengths including what makes people Hiring does not have to be a difficult endeavor if you tick, what instincts drive their behavior/the way they act. follow the same protocol each time. Here is a hiring check list ✔ AL WAYS get input from your current staff in an attempt to to help you do just that. Let it serve as a guideline. reduce unwanted personality clashes.

Prepare Before Finalizing ✔ Prepare a written job description for the position you want ✔ Schedule a second interview before offering an applicant to fill in advance so that you can clearly outline to your the job. It will either confirm or refute your first impressions. applicant what his/her responsibilities and tasks will be ✔ T ake an applicant that you are seriously considering to lunch. upon taking this job. You may find that while they come prepared to put on their ✔ A ttach a starting salary to your job description, including best show during the interview; you may see a different side benefits, wage increase opportunities and salary caps, if to them when catching them off applicable. guard. What to look for? Manners, ✔ R equest a cover letter from your basic communication skills, applicant so you can review appreciation, understanding, etc. these ahead of their interview. “How would you handle….” The way they treat service people This letter gives you a peek is the way they will treat your into their enthusiasm, tone, patients. communication abilities and sentence structure. Ms. Homisak, President of SOS Healthcare & Management ✔ R equest a resume. This will allow you to look for red flags Solutions, has a Certificate in Human Resource Studies from (gaps of unemployment in work history, etc.) Cornell University School of Industry and Labor Relations. She is the 2010 recipient of Podiatry Management’s Lifetime Do your Homework Achievement Award and recently inducted into the PM ✔ Check their references; letters of recommendation. While Hall of Fame. Lynn is also an Editorial Advisor for Podiatry calling their references will only give you limited information, Management Magazine and recognized nationwide as a it is interesting to hear how previous employers for example, speaker, writer and expert in staff and human resource respond to your questions. Sometimes it’s not what they management. say, but what they don’t say that is revealing! ✔ Do background checks! Especially if their job entails handling money and finances.

the Canadian PODIATRIST • Spring 2017 27 CFPM 2017 Annual Conference

Nov. 10 – 11, 2017 Hilton Meadowvale Mississauga, ON

The CFPM Annual Conference is Canada’s premier podiatry/chiropody conference. • Sold out exhibit hall with approx.. 60 booths • Over 250 delegates in 2016 • 3 full concurrent tracts for practitioners • 1 full tract dedicated to assistants • Workshops, preconference program (including CPR recertification), networking and more!

Confirmed Speakers Professor Hylton Menz, Australia – One of the world’s leading researcher in Podiatry. – Topics include: Hallux Valgus by Nature or Nurture First Metatarsalophalangeal Joint Osteoarthritis: Epidemiology, assessment and management

Lynn Homisak, U.S.A Back by popular demand with topics for both practitioners and assistants

Paul Harradine, UK – Leading expert in podiatric biomechanics – T opics include the Unified Theory of Foot Function and the Medial Oblique Shell Inclination

Tim Kilmartin, UK – Podiatric Surgeon – T opics include Cortisone Injection Therapy in Podiatry and Corn Cutting in the 21st Century Look for a complete program and registration Joan Weir, Canada in the summer of 2017. – Director, Health and Dental Policy HOPE TO SEE – Canadian Life and Health Insurance Assocation YOU THERE! – “Chir opody, Podiatry and Third Party Insurance: Moving Forward”

28 the Canadian PODIATRIST • Spring 2017 Foot Health Month May 2017

Raise awareness during Foot Health Month. “Let’s talk about your feet” As a CFPM member, one of the benefits you receive is access to new and exciting Foot Health Month promotional products. During the month of May, join CFPM members and others around the world to spread the word on the beneficial services provided by chiropodists and podiatrists. All CFPM* members will receive a Foot Health Month May is Foot Health Month! Promotion Package in the mail containing,

1. “Let’s talk about your feet” Foot Health Month posters Talk to your chiropodist or podiatrist about 2. “Let’s talk about your feet” post cards to distribute the treatment and prevention 3. A form letter to send to your local government and/or of foot problems. mayor for proclamation

Additional posters and postcards can be ordered at no extra Visit www.podiatryinfocanada one near you or call to find charge. All you do is pay for shipping. 1-888-706-4444

New for 2017: Nation-Wide Radio Campaign The CFPM has committed to a nation-wide radio campaign. Listen to your radio as the CFPM takes to the waves to promote *Not a CFPM member? Apply for membership TODAY at foot health and podiatrists and chiropodists across Canada. www.podiatryinfocanada.ca. Need to renew your CFPM For a list of radio stations participating in the campaign visit membership? Renew at www.podiatryinfocanada.ca or call our website at www.podiatryinfocanada.ca 1-888-706-4444. A letter writing campaign will be undertaken with the objective of educating the different levels of government on Take the Foot Health Month Challenge. the role of chiropodists and podiatrists and recognising foot Get out there and promote the profession, your clinic and health month. yourself. Submit a photo, video and/or a summary of your Foot Health Month activities and you may win. Returning in 2017: Comfort Socks by SIMCAN • 1s t Place: Free 2017 Annual Conference registration Patterned from Canada’s top selling health socks but designed (approx.. value $525) to provide your patients with additional warmth and moisture absorbency. • 2nd Place: One free case of priMED nitrile or vinyl Socks are available to purchase at 50% of cost through the gloves (approx.. value $120) CFPM to assist with promotion of Foot Health Month. Available • 3rd Place: Free book: (31 ½ Essentials for Running while supplies last. The price for CFPM embers is $2.00 per Your Medical Practice, value $69.95) pair plus HST and shipping. Please contact the CFPM via email at [email protected] or call 1-888-706-4444. Whatever your plans are: community speaking; open house; Thank you to SIMCAN for their generous sponsorship Foot special clinic activities show us your success! Submit your Health Month and partnership with the CFPM. entries before May 31, 2017. Email your entries with your name and contact information to [email protected]. Possible uses: Only CFPM members are eligible to enter. – hand out socks to patients during Foot Health Month – hand out socks at a presentation or open house to promote Foot Health Month – deliver to referral sources as a way to say “Thank you”

the Canadian PODIATRIST • Spring 2017 29 Continued from page 11 Although biological drugs have been known to rarely provoke PPP eruptions in patients, there therapeutic use for doubt on its origins as a true psoriatic variant suggesting it to PPP is only emerging. Rapso & Torres [45] in looking at future be a separate disease. Other authors have also argued it to be therapies undertook a review of progress to date using these a co-morbidity [38] citing the lack of genetic susceptibilities agents. In their paper they highlighted how many studies of the but also observing how the two conditions may arise drugs in psoriasis have excluded patients with PPP but some together. Additionally, PPP may arise without psoriatic lesions reports of improvements in patients with PPP are emerging. elsewhere and that studies have shown that psoriatic arthritis is not associated with PPP [39]. Other clinical differences Conclusion with psoriasis that have been reported include the higher Palmoplantar pustulosis is an uncommon autoimmune female preponderance, the later age of onset [40], the strong disease characterised by sterile pustules and hyperkeratosis association with smoking [9]. Differences in nail symptoms of the palms and soles. The condition is most likely to have also been examined. Patients with psoriasis tend to be a distinct entity from psoriasis, based on the clinical have more pitting and a faster nail growth whilst growth rates comparisons in published case control studies. Current work in patients with PPP have been shown to be normal [41]. suggests the disease is an immune mediated destruction of Abnormalities also seen in the nails of patients with PPP the acrosyringium in the palmar and plantar skin. Studies to include indentations and transverse ridging [42]. Finally, it date have suggested smoking to be a significant risk factor for is also commonly observed that treatments normally used to the development of the condition. Management to date of the treat psoriasis, fail to work on those with PPP. For example, condition is extremely challenging with few effective therapies systemic drugs, exposure to sunlight and topical treatments being recommended based on evidence. New biological seldom improves the condition, which are generally effective agents may offer hope to patients with the disorder but further for psoriasis. Although pustular psoriasis is reported as variant work is required to fully establish this. of disease affecting any part of the skin, PPP by definition is limited to the hands and feet and exhibits unique properties 1. F arley, E., et al., Palmoplantar psoriasis: A phenotypical and clinical review with introduction of a new quality-of-life assessment tool. J. Am. Acad. Dermatol., again demonstrating it as a separate condition. 2009. 60(6): p. 1024-1031. 2. Pettey, A.A., et al., Patients with palmoplantar psoriasis have more physical Management of PPP disability and discomfort than patients with other forms of psoriasis: implications for clinical practice. J. Am. Acad. Dermatol., 2003. 49(2): p. 271-5. Consensus on the treatment for PPP to date has been 3. Chung, J., et al., Palmoplantar psoriasis is associated with greater impairment of disappointing and clinically for podiatrists there is little that health-related quality of life compared with moderate to severe plaque psoriasis. may be offered to the patient in clinic using standard podiatric J. Am. Acad. Dermatol., 2014. 71(4): p. 623-632. 4. O’Doherty, C.J. and C. MacIntyre, Palmoplantar pustulosis and smoking. therapies. Urea based emollients may be of benefit with Br. Med. J. (Clin. Res. Ed). 1985. 291(6499): p. 861-4. symptomatic treatment of dryness and skin fissures. There is 5. Enforts, W. and L. Molin, Pustulosis palmaris and plantaris. A follow up study of a ten-year material. Ann. Dermatol. Venereol., 1971. 51: p. 289-94. much written on the difficulties of treating the disease as it 6. O’Doherty, C., The prevalence of cigarette smoking in patients with palmo- is often refractory with frequent relapses even when it shows plantar pustulosis. Scott. Med. J., 1984. 29: p. 54. success. Topical treatments have generally been disappointing 7. Akiy ama, T., et al., The Relationships of Onset and Exacerbation of Pustulosis Palmaris et Plantaris to Smoking and Focal Infections. The Journal of as affected skin is hyperkeratotic and therefore difficult Dermatology, 1995. 22(12): p. 930-934. for agents to penetrate. A Cochrane review in 2006 [43] 8. Rosen, K., et al., Thyroid function in patients with pustulosis palmoplantaris. concluded that the ideal treatment for PPP remained elusive J. Am. Acad. Dermatol., 1988. 19(6): p. 1009-16. 9. Miot, H., et al., Association between palmoplantar pustulosis and cigarette and that robust studies were required to make any informed smoking in Brazil: a case-control study. J. Eur. Acad. Dermatol. Venereol., 2009. decisions on potentially effective treatments. In 2014, a 23(10): p. 1173-1177. 10. Kubeyinje, E.P. and C.S. Belagavi, Risk factors for palmo-plantar pustulosis in a further systematic review was undertaken to re-examine the developing country. East Afr. Med. J., 1997. 74(1): p. 54-5. evidence for therapeutic options [44] and despite a few more 11. Michae lsson, G., K. Gustafsson, and E. Hagforsen, The psoriasis variant studies being published in the interim period, uncovered palmoplantar pustulosis can be improved after cessation of smoking. J. Am. Acad. Dermatol., 2006. 54(4): p. 737-8. a similar lack of evidence to support formation of standard 12. Eriksson, M.O., et al., Palmoplantar pustulosis: a clinical and immunohistological guidelines. In the absence of these, they reviewed the limited study. Br. J. Dermatol., 1998. 138(3): p. 390-8. 13. Co x, N.H. and S. Ray, Neutrophil leukocyte morphology, cigarette smoking, and evidence and developed consensus-based recommendations palmoplantar pustulosis. Int. J. Dermatol., 1987. 26(7): p. 445-7. for patients with PPP: 14. Murakami, M., et al., Acrosyringium is the main site of the vesicle/pustule formation in palmoplantar pustulosis. J. Invest. Dermatol., • Fir st line – potent or very potent topical corticosteroids 2010. 130(8): p. 2010-6. under occlusion (to enhance penetration). 15. Hagforsen, E., et al., Expression of nicotinic receptors in the skin of patients with palmoplantar pustulosis. Br. J. Dermatol., 2002. 146(3): p. 383-91. • Second line – oral retinoid (acetretin) and phototherapy 16. Hagforsen, E., et al., Palmoplantar pustulosis: an autoimmune disease [PUVA] precipitated by smoking? Acta Derm. Venereol., 2002. 82(5): p. 341-6. 17. Naik , H.B. and E.W. Cowen, Autoinflammatory Pustular Neutrophilic Diseases. • Third line – ciclosporin or methotrexate (with the latter Dermatol. Clin., 2013. 31(3): p. 405-425. having less evidence of effectiveness) Continued next page

30 the Canadian PODIATRIST • Spring 2017 Continued from previous page 31. F ransson, J., K. Storgards, and H. Hammar, Palmoplantar lesions in psoriatic patients and their relation to inverse psoriasis, tinea infection and contact allergy. Acta Derm. Venereol., 1985. 65(3): p. 218-23. 18. Reyes-Habito, C.M. and E.K. Roh, Cutaneous reactions to chemotherapeutic drugs and targeted therapy for cancer: Part II. Targeted therapy. J. Am. Acad. 32. Yiannias, J.A., R.K. Winkelmann, and S.M. Connolly, Contact sensitivities in palmar 39 Dermatol., 2014. 71(2): p. 217.e1-217.e11. plantar pustulosis (acropustulosis). Contact Dermatitis, 1998. (3): p. 108-11. 19. English, P.L. and R. Vender, Occurrence of plantar pustular psoriasis during 33. Liu, F., et al., The spontaneous regression of palmoplantar pustulosis following treatment with infliximab. J. Cutan. Med. Surg., 2009. 13(1): p. 40-2. removal of dental amalgams: A report of two cases. Australas. J. Dermatol., 2016. 57(3): p. e93-e96. 20. Brunasso, A.M.G. and C. Massone, Plantar pustulosis during rituximab therapy for rheumatoid arthritis. J. Am. Acad. Dermatol., 2012. 67(4): p. e148-e150. 34. Song, H., W. Yin, and Q. Ma, Allergic palmoplantar pustulosis caused by cobalt in cast dental crowns: a case report. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. 21. V enables, Z.C., S.S. Swart, and C.S. Soon, Palmoplantar pustulosis secondary Endod., 2011. 111(6): p. e8-10. to rituximab: a case report and literature review. Clin. Exp. Dermatol., 2014: p. Early view online. 35. Yanagi, T., et al., Zinc dental fillings and palmoplantar pustulosis. Lancet, 2005. 366(9490): p. 1050. 22. Seol, J.E., et al., Palmoplantar Pustulosis Induced by both Adalimumab and Golimumab for Treatment of Ankylosing Spondylitis. Ann Dermatol, 36. Zachariae, H., et al., HL-A antigens in pustular psoriasis. Dermatologica, 1977. 154 2016. 28(4): p. 522-3. (2): p. 73-7. 23. Somers, E.C., et al., Are Individuals With an Autoimmune Disease at Higher Risk 37. Asumalahti, K., et al., Genetic analysis of PSORS1 distinguishes guttate psoriasis 120 of a Second Autoimmune Disorder? Am. J. Epidemiol., 2009. 169(6): p. 749-755. and palmoplantar pustulosis. J. Invest. Dermatol., 2003. (4): p. 627-32. 24. Gimenez-Garcia, R., S. Sanchez-Ramon, and L. Cuellar-Olmedo, Palmoplantar 38. Christophers, E., Comorbidities in psoriasis. J. Eur. Acad. Dermatol. Venereol., 20 pustulosis: a clinicoepidemiological study. The relationship between tabacco 2006. (s2): p. 52-55. use and thyroid function. J. Eur. Acad. Dermatol. Venereol., 2003. 17: p. 276-279. 39. Ammoury, A., et al., Palmoplantar pustulosis should not be considered as a 22 25. Agner, T., et al., Thyroid disease in pustulosis palmoplantaris. Br. J. Dermatol., variant of psoriasis. J. Eur. Acad. Dermatol. Venereol., 2008. (3): p. 392-393. 1989. 121(4): p. 487-91. 40. Kwon, H.H., I.H. Kwon, and J.I. Youn, Clinical study of psoriasis occurring over 26. Rosen, K., H. Mobacken, and L.A. Nilsson, Increased prevalence of antithyroid the age of 60 years: is elderly-onset psoriasis a distinct subtype? antibodies and thyroid diseases in pustulosis palmoplantaris. Acta Derm. Int. J. Dermatol., 2012. 51(1): p. 53-58. Venereol., 1981. 61(3): p. 237-40. 41. Bu rden, A.D. and D. Kemmett, The spectrum of nail involvement in palmoplantar 134 27. Be cher, G., L. Jamieson, and J. Leman, Palmoplantar pustulosis – a pustulosis. Br. J. Dermatol., 1996. (6): p. 1079-1082. retrospective review of comorbid conditions. J. Eur. Acad. Dermatol. Venereol., 42. Hiraiwa, T. and T. Yamamoto, Nail involvement associated with palmoplantar 2014: p. n/a-n/a. pustulosis. Int. J. Dermatol., 2016: p. n/a-n/a. 28. Hagforsen, E., et al., Women with palmoplantar pustulosis have disturbed 43. Marsland, A.M., et al., Interventions for chronic palmoplantar pustulosis. calcium homeostasis and a high prevalence of diabetes mellitus and psychiatric The Cochrane database of systematic reviews, 2006(1): p. Cd001433. disorders: a case-control study. Acta Derm. Venereol., 2005. 85(3): p. 225-32. 44. Sevrain, M., et al., Treatment for palmoplantar pustular psoriasis: systematic 29. Ashurst, P.J., Relapsing Pustular Eruptions of the Hands and Feet. Br. J. Dermatol., literature review, evidence-based recommendations and expert opinion. 1964. 76: p. 169-80. J. Eur. Acad. Dermatol. Venereol., 2014. 28: p. 13-16. 30. Thomsen, K. and P. Osterbye, Pustulosis palmaris et plantaris. Br. J. Dermatol., 45. Rapo so, I. and T. Torres, Palmoplantar Psoriasis and Palmoplantar Pustulosis: 1973. 89(3): p. 293-6. Current Treatment and Future Prospects. Am. J Clin. Derm., 2016. 17(4): p. 349-358.

the Canadian PODIATRIST • Spring 2017 31 Classified Ads

Chiropody/Podiatrist Contact Email: [email protected] and meaning, and communicates in an Position Available Contact Tel: 905-272-0909 honest manner to make sure there is – Hamilton/St. Catharines, ON Salary: Competitive – To be negotiated mutual understanding between patient and Start Date: ASAP practitioner. Our Busy Foot Clinic in Hamilton/St. Catharines Hours: Full time Please forward us your resume to: is looking for a passionate and motivated Hours of Operation: M-F 10am – 7pm Chiropodist /Podiatrist to join our team (new [email protected] graduates welcome). The successful candidate Chiropody/Podiatry Position For more information on our company please will have excellent clinical, interpersonal and Available – Caledon, ON visit our website at www.footclinic.co, or on organizational skills. They will hold a current facebook at Foot Clinic Caledon practice license and in good standing with the Our Busy Foot Clinic in Caledon is looking College of Chiropodist of Ontario. for a passionate and motivated Chiropodist/ Practice for Sale – Cambridge, ON Podiatrist to join our team (new graduates Please contact at: 905-537-0858 welcome). The successful candidate will Looking to start your own practice? have excellent clinical, interpersonal and Rather than start from scratch why not consider Clinic Office Space for Rent organizational skills. They will hold a current buying an existing practice and start making in Kitchener, ON practice license and in good standing with money right away. the College of Chiropodist of Ontario. This Treatment rooms available for rent in opportunity is starting as part-time and room • All equipment included. multidisciplinary clinic. There is currently an for full time opportunity. • Good patient base with room for growth. established RMT with a full-time practice, and (Add surgery) we are looking to add health professionals to Overview: build our team. Great opportunity for cross- The Chiropodist / Podiatrist will be responsible • 2 4 years of serving Cambridge full time for assessing and treating foot conditions in referrals. Located on a busy intersection close (Monday to Friday). a clinical setting. The Chiropodist / Podiatrist to downtown, expressway, and public transit. • Lease expires in November 2017. is expected to provide foot care in a timely Directly on future LRT line. Positive, friendly, Can be renegotiated. manner. The Chiropodist / Podiatrist is and professional work environment. Available expected to contribute and create a safe I’m looking to retire but, will stay on to immediately. and healthy environment for patients, staff facilitate a smooth transition. Please contact Cristina at: and others, working in compliance with the Contact [email protected] [email protected] or 519-749-0123 standard of practice expected by the College of Chiropodists of Ontario. Third podiatrist required for busy Chiropody Position Available Job Duties: Brandon Manitoba practice – Toronto, ON • P erforms treatments, health education/ We require a self motivated podiatrist counselling for diseases, disorders and A well established multi-disciplinary clinic with who is open to learning new skills and is dysfunctions of the foot and other clinical 3 locations in the west end of the G.T.A offering willing to learn. We handle a wide range of foot care activities according to the College of Chiropractic, Physical & Massage Therapy, musculoskeletal-skeletal conditions, high risk Chiropodists of Ontario. Laser & Traditional Acupuncture and complete rheumatoid/diabetic and PVD, wound care foot care services for over 10 years. • The individual should be able to have full and paediatric cases. We provide diabetic knowledge of the scope of the Podiatric management and assessment including a new Duties include: Complete foot care services & Medicine: i.e.: being able to Rx drugs within summit Doppler vista ABI and toe examination range of devices from gait analysis to wound the scope of practice, perform injectable, equipment. care including bio-mechanical assessments, soft tissue surgeries within the scope, nail surgery, custom orthotics, orthopedic This is a excellent and lucrative opportunity biomechanical and gait analysis, and work shoes, lymphedema garments custom bracing for the right person looking to gain invaluable with patients of all ages compression socks and shockwave therapy experience, success and a business • Ensures chiropody areas, resources, opportunity with view to partnership. Salary and Seeking an enthusiastic, self-motivated materials and equipment are maintained; profit sharing initially. Brandon is a clean safe licensed Chiropodist in good standing with city and real estate is still affordable. great interpersonal, time management & • Demonstrat es competency and computer skills who is a team player and professionalism; consistently demonstrates Candidate must be able to obtain license with works well with others in a multi-disciplinary knowledge and expertise following the the college of Podiatrists of Manitoba. Must environment. standards of practice expected by the College have drivers license and CPR/first aid certified. of Chiropodists of Ontario; Contact Name: Ph ysioCare & Rehab Send resumé to Dr Michael Ball Monica Gonzales • Demonstrat es strong written and [email protected] Office Manager communication skills; listens for clarity

32 the Canadian PODIATRIST • Spring 2017 Classified Ads

Continued from previous page licensed and in good standing with the College • Fle xible starting date (although we are Chiropodist: At Dundas of Podiatrists of Manitoba and, the applicant hopeful to fill this position as soon as Chiropractic Centre – Oakville, ON must hold a current driver’s license. possible) Opportunity for part-time (16hrs/wk to build) Please email résumé to: [email protected] Interested candidates are asked to please chiropodist in Oakville. Very solid patient base e-mail your cover letter and resume (and/or of footcare (17 years of footcare & orthotics). Seeking ENTHUSIATIC and EAGER curriculum vitae) to [email protected] We are looking for someone excited to strive Chiropodist to join the Advanced and grow to full-time. Your skills include: Foot & Orthotic Clinic team! Assistant Professor, Chiropody, • Ex cellent communication, critical thinking Are you energetic and friendly? Are you a Full Time – Michener Institute and interpersonal skills- effectively team player that is always striving to deliver Position Summary communicate with administration staff, the best care? Do you want to be part of a • T each assigned laboratory/clinical and management and other health professionals. comprehensive foot clinic? clinical stimulation sessions • A bility to work independently and as member Advanced Foot & Orthotic Clinic in Midland, • Mar ks, and assesses prepared work and of an interdisciplinary team. Ontario is currently seeking a FULL TIME examinations and provides feedback to • Pr oven flexibility and adaptability in REGISTERED CHIROPODIST. All Chiropodists students a fast-paced environment- excellent and Podiatrists (including new graduates • Must be be committed to continuous quality time management, organizational and and current students) are welcome to apply! improvement and demonstrate flexibility in prioritizational skills as relates to patient care. Our growing clinic requires an individual that improving methods of engage and support provides the highest quality of Chiropody care students • Com pleting patient assessments, with the utmost attention to customer service. recommending and implementing treatment Our clinic will provide you with support staff, • Challenges thought processes, fosters plans by utilizing the full range of chiropody up to date equipment, and a warm and friendly collaboration, and develops the ability of practice. work environment. students to engage in critical and rational • De veloping strong relationships with patient thinking We are keen to hire a high energy candidate by understanding their needs and developing that would like to build a career with us! You • Pla ys a role in all aspects of course/program appropriate treatment plans. can succeed in our practice if you are a person assessment, evaluation and improvement • Successfully maintaining patient retention who gets things done and thrives on working • T eam player who works with colleagues and and follow-up appointments. with others. the Academic Chair to ensure delivery of the • Collaborating with other disciplines to provide Located just 90 minutes north of Toronto, best education experience comprehensive patient care. Midland offers a tight knit community Position Qualifications • Committ ed to and participating in ongoing atmosphere and recreational opportunities • Diploma in Chiropody (minimum requirement) that are unlike any other. With beaches, trails quality improvement in the organization. • T eaching experience an asset and boating in the summer, and skiing and Please forward resume to snowmobiling in the winter, living on the • Maintains registration in good standing with [email protected] shores of the Georgian Bay is like bringing the College of Chiropodists of Ontario your cottage home! • Demonstrat ed clinical experience and Podiatry Position Available: Advanced Foot & Orthotic Clinic offers: currency in the field of Chiropody (3 to 5 Winnipeg, Manitoba years’ experience considered an asset) • A friendly, positive and encouraging work A great opportunity exists for a Podiatrist to environment • Fluency with Microsoft Office applications join a growing, well established, and friendly practice; with a client base of 25 years. The • A state of the art facility with 10 completely • Exhibits strong organizational, practice is located in a modern, 4 chair clinic stocked treatment rooms communication and leadership skills within a professional building which includes • A cohesive, well trained and efficient • Health Clearance up to date including VPC orthopaedics and physiotherapy. This position support staff (with Clinical Assistants, and • Current membership OSC or CFPM has excellent long term prospects for the right Administrative Staff) applicant. • Satisfactory Canadian Police Clearance • Com petitive, negotiable, remuneration document required upon hire Minimum educational requirement is a BSc Podiatric Medicine, or equivalent, and at least • Peer mentorship Qualified applicants are invited to submit two years post graduate experience. • F unded educational opportunities a detailed resume and cover letter noting posting #17-04FTR to: The applicant must be motivated, enthusiastic, • Stat e of the art equipment including: nail The Michener Institute and reliable; with excellent standards of clinical and verruca laser, VeriScan Podiatric Human Resources care and interpersonal skills. He/she must Scanner, therapeutic laser, dermatoscope, 222 St. Patrick Street be proficient in all aspects of general practice orthotic lab with ability to modify orthotics, Toronto, ON M5T 1V4 including nail surgery, biomechanics and comprehensive sterilization area [email protected] diabetic foot-care. The applicant will need to be

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34 the Canadian PODIATRIST • Spring 2017 Upcoming Events

2017 July 13 – 17, 2017 Oct. 13 – 15, 2017 July 12 – 15, 2018 Big Sky Conference Advance by Podiatry Today The National – APMA Conference April 5 – 9, 2017 Big Sky, MT www.podiatrytoday.com Washington, DC Symposium of Advance Wound Care www.podiatryinstitute.com www.apma.org San Diego, CA Oct. 14 – 21, 2017 www.sawc.net July 20 – 23, 2017 36th Annual Hawaii Conference July 29 – Aug. 4, 2018 AOSSM 2017 Annual Meeting www.internationalfootankle.org International Association for April 7 – 9 , 2017 Toronto, ON Identification Foot & Ankle Surgery www.sportsmed.org Nov. 1 – 4, 2017 San Antonio, TX Little Rock, AR AAPPM Fall Conference www.theiai.org www.podiatryinstitute.com July 27 – 30, 2017 Atlanta, GA The National – APMA Conference www.aappm.org April 8 – 9 , 2017 Nashville, TN 2019 PFA Conference www.apma.org Nov. 2 – 4, 2017 Toronto, ON Superbones Superwounds West July 11 – 14, 2019 Aug. 3 – 6, 2017 www.pedorthicscanada.ca Las Vegas, NV The National Pacific Coast Conference www.superbonessuperwoundswest.com Salt Lake City, UT Portland, OR April 20 – 23, 2017 www.apma.org www.podiatryinstitute.com Valley of the Sun Podiatry Nov. 9 – 12, 2017 Conference Aug. 11 – 17, 2019 Aug. 6 – 12, 2017 2017 Clinical Conference Phoenix, AZ International Association for International Association for King of Prussia, PA Identification www.podiatryinstitute.com Identification www.goldfarbfoundation.org Atlanta, GE Reno, NV April 27 – 30, 2017 www.theiai.org Nov. 10 – 11, 2017 www.theiai.org Midwest Podiatry Conference CFPM 18th Annual Conference Chicago, IL Aug. 19 – 28, 2017 Mississauga, ON www.midwestpodconf.org 2020 Tuscany Adventure www.podiatryinfocanada.ca (Florence & Siena) July 23 – 26, 2020 May 4 – 7, 2017 www.internationalfootankle.org Nov. 16 – 19, 2017 The National Surgical Pearls by the Sea Wounds Canada Fall Conference Boston, MA Newport, RI Sept. 6 – 9, 2017 Mississauga, ON www.apma.org www.podiatryinstitute.com Montana Meeting www.woundscanada.ca Missoula, MT Aug. 9 – 15, 2020 May 12 – 13, 2017 www.goldfarbfoundation.org International Association for Wounds Canada Spring Conference Nov. 16 – 18, 2017 Identification Kamloops, BC Sept. 15 – 17, 2017 College of Podiatry Annual Orlando, FL www.woundscanada.ca CFPM Pedorthic Training for Conference Chiropodists and Podiatrists Liverpool, England www.theiai.org May 19 – 21, 2017 Timmins, ON www.scpod.org Superbones Superwounds East More information available on 2021 Teaneck, NJ www.podiatryinfocanada.ca Nov. 29 – Dec. 2, 2017 www.presentconferences.com after May 1, 2017 2017 Desert Foot July 22 – 25, 2021 Phoenix, AZ The National Sept. 14 – 17, 2017 May 24 – 26, 2017 www.desertfoot.org Orlando, FL Australasian Podiatry Conference TPMA Southwest Foot & Ankle www.apma.org Melbourne, AU Conference Dec. 1 – 3, 2017 www.apodc.com.au Frisco, TX 2017 Diabetic Foot Update Aug. 1 – 7, 2021 www.txpma.org San Antonio, TX International Association for June 15 – 17, 2017 Identification Sept. 15 – 17, 2017 www.txpma.org 39th Annual Seattle Conference Nashville, TN Podiatric Residency Education www.internationalfootankle.org www.theiai.org Summit Dec. 1 -3, 2017 June 22 – 25, 2017 Teaneck, NJ Windy City Podiatry Conference TPMA 100th Annual Conference www.presentconferences.com Chicago, IL July 27 – 30, 2017 www.podiatryinstitute.com Sept 28 – 30, 2017 Austin, TX 23rd Annual Las Vegas www.txpma.org www.internationalfootankle.org 2018 June 22 – 25, 2017 Oct. 5 – 8, 2017 April 19 – 22, 2018 Footprints by the Sea IPED Fall Meeting Midwest Podiatry Conference Hilton Head, SC Coraopolis, PA Chicago, IL www.podiatryinstitute.com www.podiatricexcellence.org www.midwestpodiatryconference.org June 22 – 25, 2017 Oct. 6 – 8, 2017 June 24 – 28, 2018 The Western Podiatry Conference Mid-Atlantic Conference FPMA Symposium Anaheim, CA College Park, MD Orlando, FL www.thewestern.org www.podiatryinstitute.com www.emedevents.com

the Canadian PODIATRIST • Spring 2017 35